Torsion of a fallopian tube: a rare cause of lower abdominal pain in a female of reproductive age

Janitha R Costa,James Moohan

doi:10.4038/sljog.v33i2.4009

Abstract

Isolated unilateral torsion of a fallopian tube is an infrequent but significant cause of acute lower abdominal pain in a female of reproductive age. We present a literature review and the case of a 41-year old lady who presented with sudden onset right-sided lower abdominal pain radiating to right thigh. Clinical examination revealed tenderness in the right lower quadrant of the abdomen and a tender right adnexal mass was noted on vaginal examination. Transvaginal scan revealed an elongated, multiloculated right adnexal mass and a normal left ovary. No free fluid or ascites were noted. Torsion of a right hydrosalpinx was suspected and an emergency laparoscopy was performed which confirmed the diagnosis and a right salpingectomy was carried out. Isolated torsion of a fallopian tube should be considered in the differential diagnosis of lower abdominal pain in any female of reproductive age, particularly when she has a history of tubal sterilisation, oophorectomy and/or pelvic adhesive disease. Key words: torsion; fallopian tube; hydrosalpinx; adnexal mass; salpingectomy. DOI: <a href="http://dx.doi.org/10.4038/sljog.v33i2.4009">http://dx.doi.org/10.4038/sljog.v33i2.4009</a> Sri Lanka Journal of Obstetrics and Gynaecology 2011; 33: 63-64

Highlights

Isolated torsion of the fallopian tube was first reported in 1890 by Bland-Sutton[1]
Our patient had previously undergone tubal sterilisation using filshie clips and right oophorectomy which allowed the tube more freedom to rotate and the filshie clip which acted as the fulcrum
When evaluating a female patient with acute lower abdominal pain, tubal torsion may not be high in the list of differential diagnosis with diagnosis often being made at the time of surgery

Summary

Introduction

Isolated torsion of the fallopian tube was first reported in 1890 by Bland-Sutton[1]. Clinical examination elicited tenderness in the right lower quadrant of the abdomen but there were no evidence of peritonism. Bimanual pelvic examination revealed a tender mass in the right adnexa. Transvaginal ultrasound examination (sonosite 4Mhz) showed an elongated, multiloculated mass measuring 7.8 cm x 5.26 cm in the right adnexal region (Figure 1).

Results

Conclusion